We live in a busy world and it’s easy to overlook the signposts for potential health issues. So, when you are
recording the medical history of your patients or training for medical emergencies with your practice team, make a mental note to consider your own wellbeing too.
Medical emergencies involving patients or team members can happen, so it’s always best to be prepared. As the GDC’s Scope of Practice 2013 says: “A patient could collapse on any premises at any time, whether they have received treatment or not. It is therefore essential that all registrants are trained in dealing with medical emergencies, including
resuscitation, and possess up-to-date evidence of capability.”
Stroke
If someone has a stroke in your practice it can be a particular challenge because it is a potentially sudden ‘illness’ that could have significant effects on you, your patient or your team. It is your duty as a healthcare professional to be mindful of the possibility of it happening and to be aware of the signs and symptoms.
A stroke occurs approximately 152,000 times a year in the UK – that is one every three minutes and 27 seconds. One in four strokes are fatal within a year and it is the fourth single largest cause of death in the UK. Stroke is also the biggest cause of complex disability worldwide, with an estimated 1.2m stroke survivors in the UK today.
Wendy Berridge delivers medical emergencies training to dental practices. She says: “The prognosis for stroke patients is variable, but the mortality rate is around 30 per cent when the stroke is caused by a plaque, or blood clot, and as high as 80 per cent when caused by a haemorrhage.”
Types of stroke
Wendy explains: “There are two types of stroke. The most common is caused by the presence of an atheromatous
plaque, or less commonly a blood clot, that blocks one of the blood vessels supplying part of the brain; this results in the death of the area of the brain the blood vessel supplies. The second cause is less frequent, it occurs when a blood vessel in the brain ruptures, resulting in a haemorrhage which causes an area of the brain to become ‘squashed’ by the pressure of the blood. In either type of stroke, the signs and symptoms are very similar and an area of the brain will die.
“A Transient Ischaemic Attack (TIA) or mini-stroke is caused by a temporary disruption of blood flow to part of the brain. Symptoms may be similar to a cerebrovascular accident (CVA) but recovery occurs within 24 hours. However, 20 per cent of people who experience a TIA will suffer a full CVA within a few weeks, therefore TIAs should be regarded as a warning sign that further TIAs or a complete stroke may occur in the future.”
FAST
A stroke is a medical emergency and urgent treatment is essential – the sooner a person receives treatment for a stroke, the less damage is likely to happen. A quick response can minimise damage to the brain and aid a full recovery. Conversely, a delay in getting help can result in death or long term disabilities. The FAST principle is one that is widely shared as a simple way of recognising symptoms:
- Facial weakness: Can the person smile? Has their face fallen on one side?
- Arm weakness: Can the person raise both arms? Can they keep them there?
- Speech problems: Can the person speak clearly? Can they understand what you say? Is their speech slurred?
- Time to call 999: if you see any one of these signs
Your dental team has a responsibility to keep up to speed on the latest thinking regarding the management of medical emergencies in practice, and all registrants must follow the guidance and training updates issued by the Resuscitation Council (UK).
Management
The response to a person who has had a CVA in your practice should be assessing and monitoring ABCDE (airway, breathing, circulation, disability, exposure) and provision of high-flow oxygen, together with an immediate call for a paramedic. It is worth remembering that although they may not be able to speak, they will probably be able to
understand what is happening, and are likely to be frightened, so a calm approach is essential.
Taking a patient’s medical history is obviously a requirement of the GDC – 4.1.1 of the Standards for the Dental Team explains that: “You must make and keep contemporaneous, complete and accurate patient records”; it’s also a helpful tool in identifying predisposing factors in patients who may have an increased risk, as well as recording details if the patient has had a CVA or TIA in the past six months, as there is a greater risk of having another.
Prevention
Just as important as the health of your patients and staff is the consideration of your own personal health protection – and it is easy to overlook this when you are tied up with the day-to-day running of a practice.
A practice principal in her late 30s suffered an unexpected stroke while at work and was signed off for just a month. She received over £2,000 from Dentists’ Provident, while she underwent a number of tests and a referral to a specialist. By putting in place suitable protection, our member was able to focus on her recovery and treatment.
Last year, a study suggested that people who have job strain may be more at risk of an ischemic stroke – although it was acknowledged that further research is needed to determine whether interventions targeting job strain would reduce stroke risk beyond existing preventive strategies. Researchers at the University of East Anglia recently suggested that people who join walking groups could reduce the risk of stroke, as well as coronary heart disease, depression and other life-threatening conditions.
There have also been a number of studies investigating an association between high magnesium intake, and a reduced stroke risk. A recent analysis of relevant studies between 1966 and 2011 – Dietary magnesium intake and risk of stroke: a meta-analysis of prospective studies – suggested that, although it may be early days to recommend magnesium supplements as a means of reducing the risk of stroke, an “increased consumption of magnesium-rich foods such as green leafy vegetables, beans, nuts, and whole-grain cereals appears to be prudent”.
Katrina Mather, founder of The Body Toolkit, a wellbeing retreat in the Scottish Highlands, agrees. She says: “For anyone at high risk of stroke, magnesium supplementation works very well both as a preventive measure, as well as treatment after a stroke to minimise damage. My advice with strokes and heart disease is always one of prevention – those who eat healthy, balanced diets, move their body regularly and are happy and can process stress, will avoid strokes.”
Chief Dental Officer for England, Barry Cockcroft, suffered a stroke in 2011. He says: “I suffered a haemorrhagic type of stroke and was told that high blood pressure was probably a factor, but I was not aware I was suffering from hypertension as there weren’t any symptoms, until it happened. Since then, the two biggest lifestyle changes I have made involve a better awareness of what I am eating and of its salt content.”
So, to play a part in reducing the figures for strokes, we may all need to make some simple, but crucial, changes to our diet, as well as offering lifestyle advice to our patients. If an emergency does strike, we should be prepared to handle it calmly, knowledgeably and effectively.
These conditions could increase your chances of a stroke:
- Hypertension
- Diabetes
- Heart Disease
- Renal Disease
- Obesity
- Atrial fibrillation
- Smoking
- Excess alcohol consumption
- Previous TIA/CVA
These are some of the signs and symptoms of a stroke:
- Paralysis of one side of the face
- Paralysis of the limbs on one side
- Confusion
- Inability to speak clearly, or at all
- Visual disturbances
- Tingling down one side of the body
- Numbness down one side
- Seizures
- Severe headache (sudden onset)
- Coma
References available on request.